Mixed methods: A justification, explication, and example

In this chapter we explain why it may be appropriate to use a mixed methods research design to address particular research questions. Mixed methods approaches involve at least two different forms of data collection that are combined in one study. Here we focus on a type of mixed methods research protocol called a concurrent nested design in which data from a quantitative survey are combined with qualitative data from in-depth interviews. Using as an example a recent study on prison adjustment and reentry, we explain how to implement a concurrent nested design in the field and why it is a valuable approach to use for certain research questions. Because the example study that we are using was interrupted by the onset of the COVID-19 pandemic, we also address how unexpected events that arise during a research endeavor can be handled to ensure the successful completion of a project. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023. All rights reserved.

Implementing the Yorkshire Cancer Research funded Prehabilitation Radiotherapy Exercise smoking Habit cessation And Balanced diet Study (PREHABS): a therapeutic radiographer's perspective

Introduction: Lung cancer patients often have a number of comorbidities which impacts patient mortality and morbidity rates. Lifestyle changes for this group of patients have the potential to positively impact both quality of life and longevity. The Yorkshire Cancer Research funded Prehabilitation Radiotherapy Exercise smoking Habit cessation And Balanced diet Study (PREHABS) was designed to determine if it is feasible to embed interventions promoting a healthier lifestyle into the radical lung radiotherapy pathway. Method(s): The PREHABS study was led by therapeutic radiographers trained in smoking cessation provision, motivational interviewing, informed consent and good clinical practice and a dietitian. Radiographers screened and consented study participants, delivered the exercise intervention and up to 12-weeks of smoking cessation support, whilst dietary advice was provided by the dietitian. Patients diagnosed with chronic obstructive pulmonary disease (COPD), were referred to a community based pulmonary rehabilitation service rather than the PREHABS exercise intervention. Ethical and regulatory approvals were secured in September 2021. Result(s): 61 patients were recruited between September 2021 and October 2022. The majority were female (n=42), mean age 73.1 years (SD 9.36 years). Discussion(s): In addition to the training requirements detailed above and the challenges of COVID-19, the radiographers had to become adept in a number of study-specific aspects including writing the study standard operating procedures (SOPs), creating a study organisational workflow and patient recruitment. The PREHABS study has broadened the radiographer's perspective beyond the radiotherapy department, by further understanding the complex comorbidities that lung cancer patients present with, how to motivate patients to positively change their lifestyle, and how the side effects caused by cancer treatment can affect a patient's ability to change their lifestyle. Conclusion(s): Therapeutic radiographers, after appropriate training, are capable of delivering lifestyle intervention support within a radical lung cancer radiotherapy pathway. Disclosure: No significant relationships.Copyright © 2023 Elsevier B.V.

Anticipatory Guidance through Online Motivational Interviewing for Mothers on Early Childhood Caries among Young Children of Age 9–24 Months amidst Pandemics: A Nonrandomized Clinical Trial

Early childhood caries (ECC) is a multifactorial disease with known etiologic factors and can be very devastating to the oral and general well-being of a child, including psychological impact on a growing child. The irony is among the different factors responsible for milk that is wholesome nutrition, if fed in a wrong pattern, can be the main factor that helps this type of rampant caries spread within no time, leading to pulp exposures and complicating proceedings. Awareness is the mainstay in prevention, and creating it becomes our sole responsibility as a pediatric dentists. A multidisciplinary approach with the involvement of mothers as a main stakeholder in this front becomes a very promising move, so this project is phase two of interprofessional collaboration involving mothers in prevention;the aim of the study is to create awareness among mothers during COVID lockdown so as to prevent ECC in this COVID pandemic. Materials and methods: A total of 222 mothers with 9–24 months old children were selected and added to the e-groups. The allocated mothers were given a pretest questionnaire and collected back with a photo of their child's oral health, and anticipatory guidance and in-depth interviewing were given to them. Follow-up is done in 2, 4, and 6 months. Awareness is evaluated by pre-and posttest questionnaires. Reversal of the white spot is evaluated through indices, and progression is noted. Statistical analysis: The data was analyzed using Statistical Package for the Social Sciences 13. Result: Pretest and postquestionnaire analysis were done using the Chi-squared test. The test shows the marked raise in knowledge, attitude, and practice of mothers on their children after postintervention, which was given through motivational interviewing (MI). Conclusion: In summary, the MI intervention appeared to improve maternal knowledge but had no effect on oral health behaviors or on the progression of early childhood caries (ECC). © The Author(s). 2023 Open Access.

A virtual pilot optimization trial for African American/Black and Latino persons with non-suppressed HIV viral load grounded in motivational interviewing and behavioral economics.

Introduction: Virtual and low-touch behavioral interventions are needed for African American/Black and Latino persons living with HIV (PLWH) with barriers to HIV viral suppression, particularly during COVID-19. Guided by the multiphase optimization strategy, we explored three components for PLWH without viral suppression, grounded in motivational interviewing and behavioral economics: (1) motivational interviewing counseling, (2) 21-weeks of automated text messages and quiz questions about HIV management, and (3) financial rewards for viral suppression (lottery prize vs. fixed compensation). Methods: This pilot optimization trial used sequential explanatory mixed methods to explore the components' feasibility, acceptability, and preliminary evidence of effects using an efficient factorial design. The primary outcome was viral suppression. Participants engaged in baseline and two structured follow-up assessments over an 8-month period, and provided laboratory reports to document HIV viral load. A subset engaged in qualitative interviews. We carried out descriptive quantitative analyses. Then, qualitative data were analyzed using directed content analysis. Data integration used the joint display method. Results: Participants (N = 80) were 49 years old, on average (SD = 9), and 75% were assigned male sex at birth. Most (79%) were African American/Black, and the remainder were Latino. Participants were diagnosed with HIV 20 years previously on average (SD = 9). Overall, components were feasible (>80% attended) and acceptability was satisfactory. A total of 39% (26/66) who provided laboratory reports at follow-up evidenced viral suppression. Findings suggested no components were entirely unsuccessful. The lottery prize compared to fixed compensation was the most promising component level. In qualitative analyses, all components were seen as beneficial to individual wellbeing. The lottery prize appeared more interesting and engaging than fixed compensation. However, structural barriers including financial hardship interfered with abilities to reach viral suppression. The integrated analyses yielded areas of convergence and discrepancy and qualitative findings added depth and context to the quantitative results. Conclusions: The virtual and/or low-touch behavioral intervention components tested are acceptable and feasible and show enough potential to warrant refinement and testing in future research, particularly the lottery prize. Results must be interpreted in the context of the COVID-19 pandemic. Trial registration: NCT04518241 (https://clinicaltrials.gov/ct2/show/NCT04518241).

Intervention Efficacy on Covid-19 Testing and Vaccination in People Who Inject Drugs

Background: People who inject drugs (PWID) are vulnerable to SARS-CoV-2 and severe disease but have low rates of COVID-19 testing and vaccination due to multilevel barriers. We partnered with a mobile syringe service program (SSP) in San Diego County, CA, to develop the theory-informed LinkUP intervention to increase COVID-19 testing and vaccination among PWID. Method(s): From March-June 2022, we conducted a pilot randomized controlled trial (RCT;ClinicalTrials.gov #NCT05181657) to assess efficacy of LinkUP vs. a didactic attention-matched control condition in increasing COVID-19 testing uptake and acceptance of vaccination referrals. Based on Social Cognitive Theory, trained, SSP-hired peer counsellors delivered tailored education, motivational interviewing, and problem-solving and planning to the active LinkUP intervention arm. We referred eligible participants (PWID, >=18 years old, San Diego County residents without recent voluntary COVID-19 testing or fully vaccinated status) to mobile SSP sites that had been randomized by week to offer LinkUP or the control condition;all participants were then offered on-site rapid COVID-19 antigen testing and vaccination referrals. Our intent-to-treat analysis used Chi-square tests to compare intervention groups' outcomes and log-binomial regression to estimate preliminary intervention efficacy and explore potential moderation. Result(s): Among 150 participants, median age was 41 years, 33% identified as Latinx and 65% as male, 73% were experiencing homelessness, and 45% had prior mandatory COVID-19 testing. Overall, we only detected one SARS-CoV-2 case. However, more active intervention vs. control participants agreed to COVID-19 testing (77.3% vs. 22.7%;p< .001) and vaccine referrals (32.4% vs. 13.3%;p=0.006). Homelessness moderated intervention effects: LinkUP increased COVID-19 testing uptake more among participants experiencing homelessness (adjusted risk ratio [aRR]: 1.64;95% CI: 1.27-2.12) than those not experiencing homelessness (aRR: 1.25;95% CI: 0.99-1.56). Conclusion(s): Findings from this RCT support the efficacy of LinkUP in increasing COVID-19 testing and acceptance of vaccination referrals among PWID presenting at mobile SSP sites, particularly for those experiencing homelessness. This research underscores the significance of communityacademic partnerships when working with PWID and identifies a promising model that could be adapted to increase access to other underutilized vaccines in this vulnerable population.

Vaccine Hesitancy: Obstacles and Challenges.

Purpose of Review: In 2019, vaccine hesitancy (VH) was named as one of the top 10 threats to global health by the World Health Organization (WHO). We highlight the factors affecting VH, the role of VH in limiting vaccine uptake and inability to achieve collective immunity, and possible solutions. Recent Findings: There are still uncertainties and concerns about the safety and efficacy of vaccines, which promote VH and undermine public confidence in immunization. WHO has designed the behavioral and social drivers (BeSD) tools and survey instruments that can be used by countries to assess reasons for poor vaccine uptake in childhood for COVID-19 and plan national vaccination programs to counter these misconceptions. Summary: Vaccines are one of the best preventative measures that public health care has to offer. Evidence from across the world both in high-income countries (HICs) and low/middle-income countries (LMICs) show that VH is a significant phenomenon which is translating into geographical clustering of epidemics. A reasonably high acceptance and coverage rates are necessary for an immunization program to be successful. A context-specific and multifactorial intervention with more high-quality research is needed globally.

The role of motivational interviewing training in supporting the practice of COVID-19 contact tracers

Purpose: To explore how motivational interviewing (MI) training might benefit the practice of COVID-19 contact tracers. Design/methodology/approach: Following co-production of a MI training package, with a United Kingdom (UK) track and trace organisation, training was delivered virtually to 101 volunteer participants involved in contact tracing. Data were captured via an online survey, incorporating questions from recognised measures of occupational self-efficacy and workplace wellbeing, prior to the training. Open data fields were used to gather feedback about participants' reasons for attending, and views about the training afterwards. Finding(s): Although the contact tracers reported high occupational self-efficacy and workplace wellbeing, both quantitative and qualitative data suggested participants saw practitioner value and utility in MI. Research limitations/implications: The sample was self-selecting and typically involved contact tracers from UK local authorities. The study did not measure impact on compliance with self-isolation guidance and/or providing details of contacts, and larger-scale research would be needed to establish this. This was not a pre-post-test evaluation study, and measures of occupational self-efficacy and workplace wellbeing were gathered to give insight into the sample and to test the feasibility of using this survey for a future large-scale study. The research was conducted during the height of the pandemic. While UK COVID-19 contact tracing services have since been reduced, there are potential implications for infection control more generally. Practical implications: MI is potentially a useful approach for enhancing contact tracing practice. However, implementation factors should be carefully considered, to ensure effective and sustainable practice. Social implications: Improved practice in contact tracing could have potential benefits in infection control, through improving compliance with central guidance, although this requires more widespread investigation. Originality/value: This is the first empirical study to investigate how MI training could benefit COVID-19 contact tracing practice.Copyright © 2023, Emerald Publishing Limited.

Vaccinator communication interventions to address HPV vaccine hesitancy

Human papillomavirus (HPV) vaccination is an effective public health tool to decrease the rates of HPV-related cancers in our communities. Vaccine hesitancy can undermine this effort, and interventions are needed to inform and assist individuals/parents in decision-making to receive vaccines. The COVID-19 pandemic and newly developed vaccines have increased attention and made families hesitant about vaccines. Receiving a provider's strong recommendation for the vaccine is one of the strongest predictors of HPV vaccine uptake. However, not all providers have the knowledge and skills to provide the best approach for families and patients. The primary communication method has been the presumptive approach. However, this may not work well with vaccine-hesitant individuals. Would another evidence-based approach, such as motivational interviewing (MI), improve vaccine uptake? A study analysis showed that the presumptive strategy remains proven;however, the MI communication strategy was less proven. However, an evidence-based intervention, DOSE HPV, endorsed by the National Cancer Institute showed promise. This DNP project implemented a quality improvement project in a public immunization clinic using the DOSE HPV model as a framework. The project purpose aimed to improve HPV vaccination rates in individuals aged 11-24 years. Staff participants received education on HPV 101 and two communication strategies, presumptive and MI approaches. The project data demonstrated a 5% increase in vaccine uptake for those aged 11-12 years and staff participants rated the educational presentation favorably. This DNP project potentially may be duplicated to include other vaccines, especially the COVID vaccine or other applications changing health behavior. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Nutritional care approaches and outcomes of health care professionals managing alcohol withdrawal patients post hospital discharge: a scoping review

Alcohol use disorder (AUD) is highly prevalent in Australia.(1) However, best practice management of AUD in the community post discharge from hospital is not well articulated in the literature. In particular, given the harmful effects excessive alcohol consumption has on nutritional status there is a need to identify what approaches are being utilised in managing this vulnerable group.(2) Hence the aim of this scoping review was to identify the current approaches and outcomes with respect to nutritional care as identified by the Nutrition Care Process Model (NCPM) for patients discharged from hospital post alcohol withdrawal. This scoping review was registered with OpenScience Framework (words: PubMed, CINAHL, Web of Science and Scopus. Articles included were published between January 1995 and April 2022 Eligible articles were screened independently by pairs of reviewers, and consensus was reached across pairs to provide inter-rater and inter-consensus reliability. Screening and data extraction was conducted using Covidence by reviewers HM, ATM, CM, SG Fourteen articles were eligible for inclusion. Approaches to nutritional care was identified based on the intervention utilised and in comparison to the NCPM.(3) Key findings were screening for nutrition related problems and anthropometry measures were the most evaluated (n = 10), whereas practices of referral providing continuum of care were highlighted in only a minority of studies (n = 3). Education interventions included Motivational Interviewing and cognitive behavioural therapy sessions (4) (n = 7). Few studies (n = 4) which combined harm-reduction counselling with nutritional approaches and education interventions showed significant improvement (p < 0.05) in outcome measures of nutritional care. This was measured through the improvement in nutritional status (positive eating habits, decrease in nutrition-related impact symptoms, and WHO Quality of Life (QoL) health and physical domains) Limitations include varying aims of analysis and a paucity of information in this area. There is a need for further studies to be completed in this area to understand the nature of this complex issue and recommend effective strategies to improve health outcomes for individuals and populations.

Telephone and Videoconferencing Collection of Personal Narratives on Intimate Subjects. Methodological Issues in Remote Interviewing to Collect Life Histories

The COVID-19 pandemic and the health and social crisis it caused led researchers to conduct semi-directive interviews either by telephone or videoconferencing. On the basis of three surveys on intimate personal matters conducted by young women and requiring life history interviews, this methodological assessment examines the ways in which remote interviewing of these kinds changes the nature of the material collected and in so doing rearranges the sociological knowledge production mode. It shows how remote interviewing renews accessible social profiles by opening a path to previously unknown configurations. It also shows the advantages of this arrangement for accessing the subject's inner thoughts, feelings, and processes, and highlights its potential for cases where asymmetrical interviewer/respondent power positions (particularly gender positions) are likely to hinder interviewer-respondent rapport, risking an impoverishment of the knowledge produced. © 2022 Editions Ophrys. All rights reserved.

Women with breast cancer, listening to the unheard voices: A qualitative study

Objective: This is a descriptive qualitative study with the aim of examining experiences of women diagnosed with breast cancer. Methods: The semi-structured interviews were conducted in the oncology clinic in Al Basheer Hospital in Jordan and included 15 women. Results: Several themes were identified such as knowledge before and after diagnosis, side effects of treatment, social and economic problems, lockdown and financial challenges in corona pandemic, coping strategies, and disclosure issues. Appropriate knowledge concerning causes of breast cancer, and side effects of administered drugs were lacking. Additionally, women were not comfortable telling others about their breast cancer diagnosis and considered it a private issue. During the COVID-19 pandemic, they faced many difficulties reaching hospitals, financial struggles, and inability to meet with their loved ones during lockdown. Conclusion: This study revealed the diversity of personalities and unique disposition of women regarding all the topics covered in the interviews. These differences should be considered in the support provided to these patients. [ FROM AUTHOR] Copyright of Electronic Journal of General Medicine is the property of Modestum Publications and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Virtual training of rheumatoid arthritis peer coaches in motivational interviewing skills and concepts of cardiovascular disease.

Background: Peer coaching interventions are effective in helping individuals with chronic conditions understand their disease. Most peer coach training programs occur in person, which has become an obstacle during the COVID pandemic. We describe our experiences with virtual training for future peer coach interventions. Methods: Individuals with rheumatoid arthritis (RA) between 40 and 75 years of age were recruited and interviewed by the research team. We conducted seven virtual training sessions focused on four main points: Listen, Discuss, Practice, and Certify. The peer coaches provided feedback throughout the program, which was used to refine the training and intervention. A post-training focus group assessed satisfaction with the training program and intervention development process. Results: Four peer coaches (3 women, 1 man) were trained, including 2 Black and 2 White individuals with advanced degrees. Their ages ranged from 52 to 57, and their RA duration ranged from 5 to 15 years. An iterative process with the coaches and researchers resulted in a nine-week training program. Peer coaches reported satisfaction, confidence, and a preference for the virtual training format. Conclusion: This virtual peer coach training program was feasible and acceptable for coaches with advanced degrees during the global COVID-19 pandemic. Our approach represents an opportunity to adapt training that has been traditionally done in person. By doing so, our approach facilitates the recruitment and training of a diverse group of coaches and promotes sustainability.

Preliminary Efficacy of a Theory-Informed Intervention to Increase COVID-19 Testing Uptake Among People Who Inject Drugs in San Diego County: Findings From a Pilot Randomized Controlled Trial.

BACKGROUND: People who inject drugs (PWID) have low rates of COVID-19 testing yet are vulnerable to severe disease. In partnership with a mobile syringe service program (SSP) in San Diego County, CA, we developed the evidence-, community-, and Social Cognitive Theory-informed "LinkUP" intervention (tailored education, motivational interviewing, problem-solving, and planning) to increase COVID-19 testing uptake among PWID. PURPOSE: To assess preliminary efficacy of LinkUP in increasing PWID COVID-19 testing in a pilot randomized controlled trial (RCT). METHODS: We referred participants (PWID, ≥18 years old, San Diego County residents who had not recently undergone voluntary COVID-19 testing) to mobile SSP sites that had been randomized (by week) to offer the active LinkUP intervention or didactic attention-control conditions delivered by trained peer counselors. Following either condition, counselors offered on-site rapid COVID-19 antigen testing. Analyses estimated preliminary intervention efficacy and explored potential moderation. RESULTS: Among 150 participants, median age was 40.5 years, 33.3% identified as Hispanic/Latinx, 64.7% were male, 73.3% were experiencing homelessness, and 44.7% had prior mandatory COVID-19 testing. The LinkUP intervention was significantly associated with higher COVID-19 testing uptake (p < .0001). Homelessness moderated intervention effects; LinkUP increased COVID-19 testing uptake more among participants experiencing homelessness (adjusted risk ratio [aRR]: 1.80; 95% CI: 1.56-2.09; p < .0001) than those not experiencing homelessness (aRR: 1.20; 95% CI: 1.01-1.43; p = .04). CONCLUSIONS: Findings from this pilot RCT support the preliminary efficacy of the "LinkUP" intervention to increase COVID-19 testing among PWID and underscore the importance of academic-community partnerships and prevention service delivery through SSPs and other community-based organizations serving vulnerable populations.

People who inject drugs (PWID) are vulnerable to severe COVID-19 disease yet have low rates of COVID-19 testing. We partnered with a syringe service program (SSP) in San Diego County, CA, to develop "LinkUP," an evidence- and community-informed intervention. Specifically, LinkUP used tailored education, motivational interviewing, and problem-solving and planning strategies to increase COVID-19 testing uptake among PWID. This study was a pilot randomized controlled trial (RCT) designed to assess the preliminary efficacy of LinkUP in increasing PWID COVID-19 testing. We referred participants (PWID, ≥18 years old, San Diego residents without recent voluntary COVID-19 testing) to mobile SSP sites that had been randomized (by week). Trained peer counselors then offered LinkUP or an educational control condition lasting the same length (~30 minutes). After either condition, counselors offered on-site rapid COVID-19 antigen testing. Among 150 participants, our analyses found that the LinkUP intervention was associated with higher COVID-19 testing uptake, especially for participants experiencing homelessness. In summary, our findings from this pilot RCT support the preliminary efficacy of the "LinkUP" intervention in increasing COVID-19 testing among PWID. This study also underscores the importance of academic-community partnerships and prevention service delivery through SSPs and other community-based organizations serving vulnerable populations.

Failing to Connect? Methodological Reflections on Video-Call Interviewing During the Pandemic

The COVID-19 pandemic prompted a reconsideration of oral history practices, at a time when face-to-face contact was widely discouraged. This article draws upon a small sample of oral history interviews conducted remotely using video-calling software, to reflect upon the longer-term place of the video-call as a tool for oral historians. There are both practical challenges and benefits in relation to online interviewing with regards to security, accessibility, and comfort. More specifically, however, this article discusses the different ways in which memory and emotion may be shared on a video call and the wider implications of the virtual setting for rapport-building and shared authority between interviewer and interviewee. © 2023 The Author(s). Published with license by Taylor & Francis Group, LLC.

A peer interview qualitative study exploring support for carers of people with comorbid autism and eating disorders.

BACKGROUND: Carers of people with eating disorders (EDs) are known to experience a lack of support, high levels of unmet needs and resulting distress. Specific support and interventions for carers may benefit both the carer, and their loved one with an ED. Individuals with co-occurring autism and EDs may present with additional needs and difficulties relating to their Autism Spectrum Condition (ASC) that impact their carers. However, there is a lack of research exploring whether carers of people with ASC and EDs have specific support needs, and what kinds of support may be most beneficial for this population. METHODS: This study used a qualitative interview design, utilising peer interviews. Eleven carers participated in interviews about their experiences as a carer, and their views on existing support systems and potential improvements. As the study took place during the initial UK coronavirus lockdown, the impact of the lockdown also emerged as a topic during the interviews. Interviews were transcribed and analysed using thematic analysis. RESULTS: Five themes were identified: challenges associated with co-occurring Autism and EDs, a lack of existing support for carers from healthcare services, the personal impact of caring for someone with both ASC and EDs, ideas for how carers can be best supported, and the impact of the coronavirus on carers. CONCLUSIONS: Carers of loved ones with both ASC and EDs described the experience as having a significant personal impact on their lives, but also experienced a lack of support from healthcare services. There was a perception that caring for someone with both an ASC and EDs presents additional challenges compared to caring for someone with an ED only, and that this population therefore requires specialised support. Recommendations for possible support options, and for further research, are outlined.

Using cognitive interviews to improve a measure of organizational readiness for implementation.

BACKGROUND: Organizational readiness is a key factor for successful implementation of evidence-based interventions (EBIs), but a valid and reliable measure to assess readiness across contexts and settings is needed. The R = MC2 heuristic posits that organizational readiness stems from an organization's motivation, capacity to implement a specific innovation, and its general capacity. This paper describes a process used to examine the face and content validity of items in a readiness survey developed to assess organizational readiness (based on R = MC2) among federally qualified health centers (FQHC) implementing colorectal cancer screening (CRCS) EBIs. METHODS: We conducted 20 cognitive interviews with FQHC staff (clinical and non-clinical) in South Carolina and Texas. Participants were provided a subset of items from the readiness survey to review. A semi-structured interview guide was developed to elicit feedback from participants using "think aloud" and probing techniques. Participants were recruited using a purposive sampling approach and interviews were conducted virtually using Zoom and WebEx. Participants were asked 1) about the relevancy of items, 2) how they interpreted the meaning of items or specific terms, 3) to identify items that were difficult to understand, and 4) how items could be improved. Interviews were transcribed verbatim and coded in ATLAS.ti. Findings were used to revise the readiness survey. RESULTS: Key recommendations included reducing the survey length and removing redundant or difficult to understand items. Additionally, participants recommended using consistent terms throughout (e.g., other units/teams vs. departments) the survey and changing pronouns (e.g., people, we) to be more specific (e.g., leadership, staff). Moreover, participants recommended specifying ambiguous terms (e.g., define what "better" means). CONCLUSION: Use of cognitive interviews allowed for an engaged process to refine an existing measure of readiness. The improved and finalized readiness survey can be used to support and improve implementation of CRCS EBIs in the clinic setting and thus reduce the cancer burden and cancer-related health disparities.

Development of PIVOT with MI: A motivational Interviewing-Based vaccine communication training for pediatric clinicians.

Delay or refusal of childhood vaccines is common and may be increasing. Pediatricians are parents' most trusted source for vaccine information, yet many struggle with how to communicate with parents who resist recommended vaccines. Evidence-based communication strategies for vaccine conversations are lacking. In this manuscript, we describe the development and perceived usefulness of a curriculum to train clinicians on a specific vaccine communication strategy as part of the PIVOT with MI study, a cluster randomized trial testing the effectiveness of this communication strategy on increasing childhood vaccination uptake among 24 pediatric practices in Colorado and Washington. The communication strategy is based on the existing evidence-based communication strategies of a presumptive format for initiating vaccine conversations and use of motivational interviewing if hesitancy persists. Focus groups and semi-structured interviews with pediatric clinicians helped inform the development of the training curriculum, which consisted of an introductory video module followed by 3 training sessions. Between September 2019 and January 2021, 134 pediatric clinicians (92 pediatricians, 42 advanced practice providers) participated in the training as part of the PIVOT with MI study. Of these, 92 % viewed an introductory video module, 93 % attended or viewed a baseline synchronous training, 82 % attended or viewed a 1st refresher training, and 77 % attended or viewed a 2nd refresher training. A follow-up survey was administered August 2020 through March 2021; among respondents (n = 100), >95 % of participants reported that each component of the training program was very or somewhat useful. These data suggest that the PIVOT with MI training intervention is a useful vaccine communication resource with the potential for high engagement among pediatric clinicians.

Remote motivational interviewing to improve patient self-care and caregiver contribution to self-care in heart failure (REMOTIVATE-HF): Rationale, design, and methodology for a multicentre randomized controlled trial.

In patients with heart failure (HF), self-care, and caregiver contribution to self-care (i.e., the daily management of the disease by patients and caregivers) are essential for improving patient outcomes. However, patients and caregivers are often inadequate in their self-care and contribution to self-care, respectively, and struggle to perform related tasks. Face-to-face motivational interviewing (MI) effectively improves self-care and caregiver contribution to self-care, but the evidence on remote MI is scarce and inconclusive. The aims of this randomized controlled trial will be to evaluate whether remote MI performed via video call in patients with HF: (1) is effective at improving self-care maintenance in patients (primary outcome); (2) is effective for the following secondary outcomes: (a) for patients: self-care management, self-care monitoring, and self-efficacy; HF symptoms; generic and disease-specific quality of life; anxiety and depression; use of healthcare services; and mortality; and (b) for caregivers: contribution to self-care, self-efficacy, and preparedness. We will conduct a two-arm randomized controlled trial. We will enroll and randomize 432 dyads (patients and their informal caregivers) in Arm 1, in which patients and caregivers will receive MI or, in Arm 2, standard care. MI will be delivered seven times over 12 months. Outcomes will be assessed at baseline and 3 (primary outcome), 6, 9, and 12 months from enrollment. This trial will demonstrate whether an inexpensive and easily deliverable intervention can improve important HF outcomes. With the restrictions on in-person healthcare professional interventions imposed by the COVID-19 pandemic, it is essential to evaluate whether MI is also effective remotely.

"Hello, can you hear me?": Narratives of online mental health counselling among Filipino adults during the pandemic

Filipinos are often reluctant to seek professional mental health (MH) help. However, literature reveals that online counselling is preferable to face‐to‐face (F2F) MH services, with the pandemic possibly magnifying technology's anonymity and disinhibiting benefits. To further explore facilitators of online MH help‐seeking, this study tapped into the lived stories of Filipino adults who experienced at least one counselling session from March 2020 to March 2022. Among 83 screened respondents, 11 semistructured interviews were transcribed and analysed following Crossley's (2000) method. Findings reveal an overarching online MH counselling narrative composed of three phases and their respective events: (a) Precounselling (Resiliency Narrative versus MH Awareness, Turning Point, and Linking versus Searching);(b) Counselling (Two‐way Introduction, Unloading and Untangling, and Decision to Maintain or Terminate);and (c) Postcounselling (Relapse and Journey towards Growth and Advocacy). Three all‐encompassing facilitators were embedded throughout the process: Autonomy, Financial Capability, and MH Institutions. Notably, participants attributed their MH help‐seeking to autonomy, despite culture and stigma, because of enabling environments that entail heightened MH literacy, positive past experiences with professional MH help, social support and encouragement, and a sense of shared reality. Benefits unique to online counselling were also apparent among participants' narratives, including alleviating geographical boundaries and added financial and personal pressures. Overall, findings posit that Filipino adults consider online counselling as a preferable alternative to F2F counselling, thus necessitating further development and institutional support. [ FROM AUTHOR]

Challenges of virtual talking therapies for substance misuse in New Zealand during the COVID-19 pandemic: An opinion piece

The COVID-19 pandemic requires us to rethink how virtual approaches might work for people who use alcohol and other drugs. Are virtual clinics only suitable for clients with whom clinicians have already formed a therapeutic relationship? How well would virtual clinics work for new clients presenting to services, for clients in acute distress, and for those with complex problems? Addressing the sustained change required to maintain substance-free lives or a safe substance-use life requires robust psychotherapeutic approaches, which have traditionally been delivered through physical contact, whether they are one-to-one or group-based interventions. The challenge during this time of the COVID-19 pandemic is to deliver effective talking therapies while avoiding physical contact. How then should services continue to offer counselling and support in such an environment? How can we learn from the COVID-19 situation to deliver treatment to individuals who may have difficulties attending traditional clinic-based care, such as those in more rural areas with transport difficulties? This article focuses on identifying practical issues and providing some solutions. Copyright © 2020 New Zealand Medical Association. All rights reserved.